Provider Demographics
NPI:1346427184
Name:KOR EAST 72ND STREET MEDICAL
Entity Type:Organization
Organization Name:KOR EAST 72ND STREET MEDICAL
Other - Org Name:MANHATTAN AESTHETIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICE
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:OWNE
Authorized Official - Last Name:ROTHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-737-0770
Mailing Address - Street 1:325 EAST 72ND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-772-7229
Mailing Address - Fax:212-737-0103
Practice Address - Street 1:325 EAST 72ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-772-7229
Practice Address - Fax:212-737-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical